Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2018013788 | MO |
NPI | 1003309147 |
---|---|
Provider Name | Mary Beth Walker |
First Address | Saint Louis, MO 63141-8221 |
Second Address | Saint Louis, MO 63141-8221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |